Kidney stones are solid pieces of material (concretions) that form in the kidneys from substances present in urine.

A stone may stay in the kidney or break loose and travel down the urinary tract. A small stone may pass all the way out of the body without causing too much pain.

A larger stone may get stuck in a ureter, the bladder, or the urethra. A problem stone can block the flow of urine and cause great pain.

What Are The Characteristics and Symptoms?

There are four major types of kidney stones.

• Calcium stones are the most common. Calcium is a normal part of a healthy diet. Calcium that is not used by the bones and muscles ends up in the kidneys. In most people, the kidneys flush out the extra calcium with the rest of the urine. People who have calcium stones retain the calcium in their kidneys.
  
• Struvite stones (sometimes known as “infection stones”) may form after an infection in the urinary system. These stones contain the mineral magnesium and ammonia, a natural waste product.
• Uric acid stones may form when there is too much acid in the urine. If you tend to form uric acid stones, you may need to cut back on the amount of meat you eat.
• Cystine stones are rare. Cystine is one of the building blocks that make up muscles, nerves, and other parts of the body. Cystine can build up in the urine to form a stone. The disease that causes cystine stones runs in families.

Symptoms:

Small stones may remain in the kidney unnoticed, or may pass without incident (sometimes called “silent stones”).

Stones that become lodged in the ureter (the tube that carries urine from the kidneys to the bladder) cause spasm and produce pain. The pain is not related to the size of the stone and often radiates from the lower back to the side or groin.

Stones 4 mm in diameter or less have a 90% chance of spontaneous passage. Stones that are 8 mm in diameter or larger usually require medical intervention.

Other symptoms of kidney stones may include the following:

• Blood in the urine (hematuria)
• Increased frequency of urination
• Nausea and vomiting
• Pain during urination (stinging, burning)
• Tenderness in the abdomen and kidney region
• Urinary tract infection (fever, chills, loss of appetite)

Who Is Most Likely To Have This Condition?

• Kidney stones are most prevalent in patients between the ages of 30 and 45, and the incidence declines after age 50.

You may be at risk for kidney stones if:

• You have hypercalciuria (high levels of urinary calcium). This can be caused by poor intestinal absorption of calcium, or from hyperparathyroidism.
• You have high levels of oxalate, uric acid, cystine, or sodium.
• You have low levels of citrate and pyrophosphate, which act as inhibitors to stone formation.
• You have UTIs (urinary tract infections)
• You have renal tubular acidosis.
• You have gout (and thus excess uric acid levels)
• You have hypertension (high blood pressure is intimately related to kidney function).
• You have congenital kidney disease.

Treatment Options

Non-Surgical Management:

This normally involves modifications to the diet and possibly addition of medications. Fluid intake should be increased, as patients with stones must increase their urinary output.

Diuretics such as hydrochlorothiazide are sometimes prescribed to reduce high levels of urinary calcium and to increase urinary volume. Patients with hypercalciuria who do not respond to thiazide therapy may be prescribed orthophosphates to reduce calcium absorption and may be given dietary calcium restrictions. Patients should not reduce their calcium intake unless their physicians advise them to do so.

Patients with elevated uric acid levels are advised to drink 3 liters of water a day and reduce excessive dietary protein. Potassium citrate or allopurinol (to inhibit uric acid production) may also be prescribed.

What Does Kidney Stone Surgery Involve?

Depending on the size, location, and composition of the stone, several different surgical approaches may be employed:

Ureteroscopy - This procedure can be used to remove or break up stones located in the lower third of the ureter. A fiber-optic instrument resembling a long, thin telescope (called a ureteroscope) is inserted through the urethra and passed through the bladder to the stone. Once the stone is located, the urologist either removes it with a small basket inserted through the ureteroscope (called basket extraction) or fragments the stone with a laser or similar device. The fragments are then passed by the patient. Ureteroscopy is performed under general or local anesthesia on an outpatient basis.

Lithotripsy - This procedure is effective for stones in the kidney or upper ureter. It uses an instrument, machine, or probe to break the stone into tiny particles that can then pass easily. Lithotripsy is contraindicated for patients with very large stones or other medical conditions.

• Ultrasonic lithotripsy uses high frequency sound waves delivered through an electronic probe inserted into the ureter to break up the kidney stone. The fragments are passed by the patient or removed surgically.
• Electrohydraulic lithotripsy (EHL) uses a flexible probe to break up small stones with shock waves generated by electricity. The probe is positioned close to the stone through a flexible ureteroscope. Fragments can be passed by the patient or extracted. EHL requires general anesthesia and can be used to break stones anywhere in the urinary system.
• Extracorporeal shock wave lithotripsy (ESWL) uses highly focused impulses projected from outside the body to pulverize kidney stones anywhere in the urinary system. The stone usually is reduced to sand-like granules that can be passed in the patient's urine. Large stones may require several ESWL treatments. The procedure should not be used for struvite stones, stones over 1 inch in diameter, or in pregnant women.

Patients undergoing lithotripsy are given a sedative and general or local anesthesia, and the procedure takes over an hour. More than one treatment may be required.

Percutaneous Nephrostolithotomy (PCN)This surgical procedure is performed under local anesthesia and intravenous sedation. Percutaneous removal of kidney stones (lithotomy) is accomplished through the most direct route to stones through the kidney. A needle and guidewire are used to access the stones. The surgeon then threads various catheters over the guidewire and into the kidney and manipulates surgical instruments through the catheters to fragment and remove kidney stones. This procedure achieves a better stone-free outcome in the treatment of medium and large stones than shock wave lithotripsy. This procedure usually requires hospitalization, and most patients resume normal activity within 2 weeks.

What Are The Advantages Of Surgery?

Large stones can be systematically destroyed, relieving patient discomfort.

How Long Does It Take?

Lithotripsy – usually over an hour.

How Many Treatments Are Required?

Lithotripsy – sometimes more than one treatment may be required

What Are My Alternatives?

• Letting the stone pass by itself.
• Dietary modification.
• Medication.

Will I Have Pain?

Anesthetic is used during the procedure, so pain should be not be a major issue. As the anesthetic wears off, there may be slight post-operative pain.

When Can I Go Back To Work Or School?

Most patients can resume normal activity within 1-2 weeks.

Who Will Perform My Treatment?

The surgery will be performed by one of our highly-trained specialists in the field.

How Much Does It Cost?

Depends on procedure. Please call TopSurgeons at 800-506-8084 for more information.

Will My Insurance Cover?

Most insurance companies will cover these procedures.